Surgery for Appendicitis Might Not be Necessary After All

If you’ve ever been through the discomfort of having your appendix surgically removed, just think: It might have all been for naught. Finnish researchers involved in a new clinical trial report that antibiotics are plenty effective at treating acute appendicitis most of the time.

The overwhelming majority of appendicitis cases are cut-and-dry. The organ hasn’t ruptured and there is no risk of infection. These uncomplicated cases can be remedied with antibiotics, and patients need only go under the knife if it looks like the appendix is getting ready to burst, according to lead researcher Dr. Paulina Salminen, a surgeon at Turku University Hospital.

She said:

“There are no severe complications associated with the antibiotic therapy, so it’s a safe option.”

About 20-30% of people with appendicitis walk through the doors of the emergency room with an appendix that is about to burst, so that means 70-80% of appendicitis patients can be treated with antibiotics.

When an appendix is perforated, however, the contents can leak out into the stomach, causing a life-threatening blood infection.

For the research, Salminen and her colleagues compared 273 patients who had an appendectomy with 257 patients treated with antibiotics. The researchers found thatapproximately 60% of those treated with antibiotics didn’t need to have an appendectomy in the 5 years after treatment.

Just 100 of the 257 patients treated with antibiotics had to have an appendectomy over the 5-year study period, including 15 patients operated on during the initial hospitalization, the study found. Of those, 70 experienced their recurrent appendicitis within 1 year of the first episode. [1] [2]

The study only looked at open appendectomy, not the less invasive laparoscopic procedure. Laparoscopic appendectomy is associated with a faster recovery time and fewer complications.

Certain subgroups of patients may fare better having surgery than being treated with antibiotics, such as patients with appendicolith, in which the appendix is obstructed with calcified deposits. However, these patients were excluded from the study. [1]

The authors wrote: [2]

“Nearly 2/3 of all patients who initially presented with uncomplicated appendicitis were successfully treated with antibiotics alone and those who ultimately developed recurrent disease did not experience any adverse outcomes related to the delay in appendectomy.

These findings demonstrate the feasibility of treating appendicitis with antibiotics and without surgery.”

By comparison, 1 in 4 of those who underwent surgery experienced complications, including infections around the incision, and abdominal pain and hernias. Just 7% of patients treated with antibiotics had complications. [3]

Salminen said:

“It’s a feasible, viable, and safe option.”

An editorial accompanying the study in JAMA proclaims that “it’s a new era of appendicitis treatment.”

Appendicitis patients treated with antibiotics face about a 40% chance of needing surgery anyway. But the idea of avoiding pain, anesthesia, scars, and all of the other unpleasantries associated with going under the knife could, for many people, make it a risk worth taking.

After all, if the worst case is ending up back in the hospital, why not try a simpler solution first?